2015 Over-the-Counter
(OTC) Benefit Catalog
As a member of Care1st Health Plan, you have an Over-the-Counter (OTC) benefit every
quarter. This benefit allows you to get OTC products you may need such as bandages, cold
and allergy medicines, pain relievers, and vitamins – at no cost to you. Benefit amounts do not
roll over, so be sure to use them before the end of every quarter. Simply call the toll-free number
OR fill out and mail the order form provided. Your order will be shipped directly to your door.
Special Benefit
for Care1st Health
Plan Members
Get Over-the-Counter
Products Every
Quarter at
No Cost
to You!
Information on how to
place your OTC order can be
found on the last page.
*B - May be covered by Medicare Part B.
*D - May be covered by Medicare Part D.
H5928_15_245_PD_OTC Accepted
You can get the following items without having to talk with
your doctor, but we always recommend that you talk with
your doctor before starting a new product regimen.
Acne Treatment
Acne Gel 10%
Benzoyl Peroxide 1.5 oz1076
$7.20
Allergy, Cold, Flu, Decongestant and Sinus
All Day Allergy Tablets
14 tabs
$8.30
Children's Dimaphen 4 oz
$6.10
Chlorpheniramine Maleate
100 tabs, 4 mg
Cromolyn Sodium
(Allergy Nasal Spray)
Cough & Cold for High
Blood Pressure 16 tabs
Diphenhist
(Antihistamine) 100 tabs
Diphenhydramine HCL
24 capsules, 25 mg
Multi Symptom
Cold Formula 24 tabs
Nasal Decongestant
Spray 12 Hr, 1oz
1426
1428
$6.60
1008 $6.00
1356 $21.40
Children's Ibuprofen
100 mg/ 5 ml
Tioconazole 1 Day Treatment
with applicator 1119 $29.10
$6.20
1423
$8.20
1421
1257
$6.90
Pain Reliever PM
Extra Strength 100 tabs1332
$11.60
Antacids and Acid Reducers
$7.90
1009 $8.30
Effervescent Pain
Reliever 36 tabs
1314
$8.90
1357
1091
$8.40
$9.50
Vapor Rub 1 oz
$8.40
1001
1105
1108
$7.30
1006 $9.50
Omeprazole *D 28 caps1110
$39.80
Anti-Arthritic
$6.00
1164
1313
$15.20
Gas-X 36 chewables, 80 mg1312$8.60
Antacid/Anti-Gas Liquid
Antidiarrheal
Arthritis Pain Reliver
100 tabs
Cough Suppressants and Expectorants
Cherry Cough Drop
30 lozenges
1056 $10.10
Diabetic Tussin DM
$9.60
1323
$7.90
Loperamide HCL *D 12 tabs1133$5.90
Cough Syrup, Expectorant1054$5.00
Pepto-Bismol
Pink Bismuth
Antifungal
Mucus Relief DM
$15.40
1317
(Guaifenesin Expectorant
and Dextromethorphan
1318
$8.40
Cough Suppressant)
30 tabs, 400-20 mg
Clotrim Antifungal Cream1047
$13.00
Terbinafine HCL Tube
1046 $16.70
Tolnaftate Cream
1064
$5.90
Anti-Itch Lotions and Creams
Bactine Solution
1142 $12.60
Pramoxine Topical Analgesic 1144 $10.80
Diphenhydramine HCL/
Zinc Acetate
Cold Sore, Fever Blister and Other
Medicated Lip Products
$8.60
$6.00
Glucosamine/Chondroitin
60 capsules
Sore Throat Lozenges
Cherry 18 lozenges
Sugar Free Cough
Drop Cherry 25 lozenges
1152 $20.60
1256 $5.90
1255 $5.40
1153 $9.10
1178
$8.00
1176
$7.10
1182
$6.40
Dental Floss 55 yards
1455
$5.90
Denture Cleaning Tablets
40 tabs
1032
$7.90
1187
$9.10
1286
$8.70
1454
$9.30
Dental/Denture Care
Fixodent
Oral Pain Relief
1140
$5.80
Hydrocortisone 1% Cream1074$5.80
Abreva
1311
$19.40
Blistex Lip Ointment
Capsaicin
1367 $11.40
Carmex
Glucosamine Joint/Muscle1114
$13.30
60 capsules
Herpecin-L Lip Balm
1003
$16.50
1468
$8.40
Guaifenesin
Cough Expectorant 60 tabs1180
$11.00
Bismatrol
(Bismuth Subsalicylate) 30 tabs 1045
Miconazole 2% Cream1135
$13.60
1346
$7.00
Famotidine *D 30 tabs
Multi Purpose Contact
Lens Solution
1115
$12.80
1002
$7.10
Chewable Antacid
150 tabs, 500mg
1308
Clotrimazole Vaginal Cream
w/applicator *D
Micanozole 3 Day Treatment 1117 $16.90
Ibuprofen 100 tabs, 200 mg1004$8.70
Menstrual Relief 24 tabs
Contact Lens Supplies
Anticandial (Yeast)
$7.10
1096
$9.30
1166
Pain Relievers and Fever Reducers
2.
Aspirin Low Dose
120 tabs, 81 mg
$4.90
Alka-Seltzer 36 tabs
Sudogest PE 36 tabs, 10 mg
(Nasal and Sinus Decongestant) 1352
Acetaminophen
50 tabs, 500 mg
Aspirin Enteric Coated
100 tabs, 325 mg
1095
Naproxen *D 100 tabs, 220 mg1097 $14.40
Nasal Spray (Saline) 1.5 oz1052$9.50
Acetaminophen
100 tabs, 325 mg
Aspirin 100 tabs, 325 mg
Children's Acetaminophen
30 chewables, 80 mg
$7.90
1090
All-Nite Cold/Flu 500-15-6.25 mg1361
Children's
Diphenhydramine HCL
Aleve 100 tabs, 220 mg1104
$14.20
Orajel Pain Relief
Rechargeable Toothbrush1450
$38.20
Tooth Brush • Colgate
Clean Adult Soft
1413
$5.20
Tooth Brush • Tek Pro
Straight Soft
1412
$4.80
Tooth Paste • Pepsodent1414
$5.90
Polident Denture Cream1324
$11.20
Releev Cold Sore Treatment 1359 $40.10
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
3.
Digestive Health
Beano 30 tabs
1316
$9.40
Lactase Capsules 60 capsules 1067 $12.30
Ear Care
Ear Drops
1190
$6.30
Ear Wax Removal System
with Rubber Bulb
1363
$9.90
Eye Care
Artificial Tears Drops
1192
$6.10
Clear Eyes Eye Drops
1199
$8.20
Eye Drops (Redness Relief)1061$6.10
Eye Wash Solution
Elbow Support
1224 $14.60
First Aid Kit
1215 $10.60
Hydrogen Peroxide
1228
Knee Support
1226 $11.70
Lantiseptic Skin
Protectant Ointment
1202 $10.60
Knee Stabilizer
1465 $27.10
Neosporin Plus
1326
$14.70
Night Wrist Support
Smart Glove
1463
$35.40
1344
$6.10
$5.10
1459 $18.50
Non-skid Shower Mat
1460 $28.50
Povidone Iodine
1203
$5.30
$8.00
Rib Belt - Male
One size fits most
1456 $25.20
$7.10
Rib Belt - Female
One size fits most First Aid and Medical Supplies
Laxatives
Wintergreen Isopropyl
Alcohol
1229
$7.40
Wrist Splint
1230 $23.90
Wrist Support
1227 $13.50
Foot Care
Callus Remover Pads 6 pads 1238 $9.80
Corn Remover Pads 9 pads
1236
$9.80
Medicated Foot Powder1240
$7.40
Hemorrhoidal Preparations
Anu-Med Suppository
box of 12
1245 $8.50
Hemorrhoidal Ointment
1066
$9.00
Hemorrhoidal Suppository
box of 12
1247
$6.60
Preparation H Cream
1248 $18.50
Pre-Moist Hemorrhoid Pads1364$12.10
100 pads
1200
Ankle Support
1225 $11.50
Antiseptic Towelettes
100 pack
Tape, Paper Surgical *B
1” X 10 yd 1217
$4.70
A&D Ointment
1201
$7.60
Tape, Paper Surgical *B
2” X 10 yd 1218
$5.90
Adult Briefs Med
32" - 44” waist
1303 $12.60
Tape, Silk Surgical *B
1” X 10 yd
1219
$5.40
Adult Briefs LG
45” - 58” waist
1304 $15.60
Hot/Cold Pack for Injury
1062
$8.50
Conforming Gauze Sterile *B
12 pads, 3” X 4 yd
1223 $15.00
Digital Ear Thermometer
1285 $16.70
Elastic Bandage 2” *B
1207
$4.50
Elastic Bandage 3” *B
1209
$4.80
Elastic Bandage 4” *B
1211
$5.20
Tape, Silk Surgical *B
2” X 10 yd 1457 $25.20
1220
Tape, Transparent Surgical *B
1” X 10 yd 1221
1300
$6.60
$7.20
1305 $15.60
$5.30
Barrier Cream
1302 $10.50
$7.00
Thermometer Digital
$9.60
1063
Incontinence Supplies
Adult Briefs XL
59” - 64” waist
Tape, Transparent Surgical *B
2” X 10 yd 1222
Underpad 23" x 36"
Washcloth w/Lanolin
Bisacodyl 100 tabs
1128
$6.50
Docusate Sodium 100 capsules 1126 $18.10
Ex-Lax 8 tabs
Glycerin Suppository
25 tabs, 2 gm
Methylcellulose
Milk of Magnesia 12 oz
1124
$8.20
1125
$6.80
$19.90
1354
1011
$8.40
Natural Vegetable Laxative1340
$16.00
Polycarbophil Fiber Tablets 1012 $13.70
90 tabs
Alcohol Pads *D
100 pads
Automatic Blood
Pressure Monitor Desktop1253
$44.40
4.
1213
Non-skid Bath Mat
1196
$7.00
Artificial Tears Ointment1194
$11.40
Adhesive Bandages (Sheer)
60 bandages
Elastic Bandage 6” *B
1299 $16.00
1348 $9.60
Senna Plus 60 tabs, 8.6-50 mg1130
$8.70
Migraine Relief
Migraine Relief 100 tabs
1365
$9.90
Wellpatch Migraine box of 4
1261 $11.10
Minerals
Calcium Carbonate Tabs
60 tabs
1291
$8.30
Calcium-Vitamin D 60 tabs
1373
$6.50
Ferrous Sulfate
100 tabs, 325 mg
1376
$7.60
Niacin 100 tabs, 100 mg
1378
$7.00
Niacin 100 tabs, 500 mg
1394
$9.60
Magnesium 110 tabs, 250 mg 1418
$8.40
Magnesium Oxide
100 tabs, 250 mg
Rena-Vite 100 tabs
1377
$9.30
1395 $21.40
Zinc Chelated 100 tabs, 50 mg 1419
$7.40
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
5.
Motion Sickness
Dramamine Orange 8 chews 1264 $10.70
Driminate 12 tabs
1263
$6.00
Meclizine 100 tabs
1366 $12.00
Pediculicide
Lice Treatment Shampoo1271
$14.00
Permethrin Cream Rinse1269
$17.70
Personal Care
Ammonium Lactate
1368 $14.30
Aloe Vera Cream
1070 $10.70
Hand Sanitizer
1065
Sunscreen Lotion SPF 15
1283 $11.10
Sunscreen Lotion SPF 30
1284 $12.80
$7.20
Sleep Aids
Nasal Strips Sm/Med box of 301724 $14.00
Nasal Strips Med/Large1725
$14.00
box of 30
Sleep Tabs 24 tabs
1276
$7.10
Smoking Cessation
Nicorelief Gum
1372 $27.00
Nicotine Patch Step 1
1369 $40.30
Nicotine Patch Step 2
1370 $40.30
Nicotine Patch Step 3
1371 $40.30
Support Items
Men's Compression Knee Hi Socks
Black Large Shoe size 101/2-12
(15-20 mmhg)
1399 $27.40
6.
Men's Compression Knee Hi Socks
White Med Shoe Size 8-10
(15-20 mmhg)
1400 $27.40
Men's Compression Knee Hi Socks
White Large Shoe Size 101/2-12
(15-20 mmhg)
1401
$27.40
Women's Compression Knee Hi Socks
Nude Small Shoe Size 4-5
(8-15 mmhg)
1406 $16.60
Women's Compression Knee Hi Socks
Nude Med Shoe Size 51/2-71/2
(8-15 mmhg)
1407 $16.60
Women's Compression Knee Hi Socks
Nude Large Shoe Size 8-101/2
(8-15 mmhg)
1408 $16.60
Women's Compression Knee Hi Socks
Black Small Shoe Size 4-5
(8-15 mmhg)
1409 $16.60
Before ordering any of the items below, you should talk
with your doctor.
Home Diagnostics
Colon Cancer Test
Home Access
Cholesterol Test
1416 $18.60
1251 $38.10
Vitamins
Centrum Silver 60 tabs
1420 $33.50
Daily Multiple Vitamin Tabs
100 tabs
1385
$7.10
Ferrous Gluconate
(Iron Supplement) 100 tabs
1375
$7.60
Iron 110 tabs, 27 mg
Multi Vitamin Children's
100 chewables
1417 $10.00
1422 $10.00
Prenatal Vitamins 100 tabs1274
$10.00
Vitamin B-1 100 tabs, 100 mg 1016
$7.50
Vitamin B-6 100 tabs, 50 mg
1380
$6.60
Vitamin B-6
100 tabs, 100 mg
1388
$7.10
Vitamin B-12
100 tabs, 500 mg
1389
$8.20
Vitamin B-12
100 tabs, 1000 mcg
1381 $11.20
Vitamin C 500 mg, 100 tabs
1017
Vitamin Century Senior
90 tabs
1392 $13.10
Vitamin D 100 tabs, 1000 iu
1390
$8.10
Vitamin D 100 tabs, 400 iu
1383
$8.00
Vitamin E 100 tabs, 100 iu
1391
$7.40
Vitamin E 100 tabs, 400 iu
1384
14.40
Vitamin One A Day 100 tabs
1393
$8.10
$6.50
Women's Compression Knee Hi Socks
Black Med Shoe Size 51/2-71/2
(8-15 mmhg)
1410 $16.60
Vitamin A 100 tabs, 10 mu
Women's Compression Knee Hi Socks
Black Large Shoe Size 8-101/2
(8-15 mmhg)
1411 $16.60
Care1st Health Plan is an HMO and an HMO SNP plan with a Medicare contract and a contract with
the California State Medicaid Program. Enrollment in Care1st Health Plan depends on contract renewal.
Topical Antibiotics
Bacitracin Ointment
1020
$5.80
Triple Antibiotic Ointment
1014
$9.90
Wart Remover
Dr. Scholl’s Wart
Removal System
1288 $19.70
Wart Remover
1075
Wartners Wart
Removal System Kit
1289 $27.90
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
$9.00
1379
$6.30
Vitamin B-Complex 100 tabs 1382
$8.20
The benefit information provided is a brief summary, not a complete description of benefits. For more
information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.
This information is available for free in other languages. Please call our Member Services at 1-800544-0088 (TTY 711) 8 a.m. to 8 p.m., seven days a week from October 1 through February 14, except
Thanksgiving and Christmas, and 8 a.m. to 8 p.m., Monday through Friday from February 15 through
September 30, except holidays.
Esta información está disponible gratuitamente en otros idiomas. Comuníquese con Servicios para los
Miembros: 1-800-544-0088 (TTY 711), de 8 a.m. a 8 p.m., los siete días de la semana del 1° de
octubre al 14 de febrero, excepto el Día de Acción de Gracias y Navidad, y de 8 a.m. a 8 p.m., de
lunes a viernes, del 15 de febrero al 30 de septiembre, excepto los días festivos.
這項免費資訊以其它語言提供。懇請聯絡會員服務處：免費熱線 1-800-544-0088 (聽障及語障人士專線
711) 從10月1日至2月14日，上午8點至下午8點，每週七天，除感恩節和聖誕節外。從2月15日至9月30
日，上午8點至下午8點，週一至週五，假日除外
7.
Helpful Information
•
•
 
If you have questions or would like to place an order over the phone, OTC
Advocates are available Monday – Friday from 8:00am to 5:00pm PST at
1-800-355-7913 (TTY 711).
If you place your order using an order form, your order total will be applied to
the quarter in which we receive your form. For example, if you mail your order
form on June 29th, but we receive it on July 1st, your order total will be applied to
your July (or third quarter) benefit, not your June (or second quarter) benefit.
If you’re getting close to the end of the quarter and you do not think your
order form will be received in time, you can call in your order.
•
We encourage you to use your full quarterly benefit amount in one order. This
benefit amount does not roll over from quarter to quarter.
•
Your order total may not exceed the quarterly benefit amount shown in the letter
you received with this catalog. Cash, checks or money orders are not accepted
under this OTC benefit.
•
Orders may only be placed by the member, an authorized representative verbally
approved by the member at time of the order, and/or the member’s power of
attorney representative on file.
•
To use your benefit, you must select products from this catalog that will help
you with a health or medical need. Your order total may not exceed your benefit
amount. OTC products are intended for members use only. Care1st Health Plan
prohibits the use of this benefit to order OTC items for family members and friends.
OTC items are available through mail-order only.
•
Once your order is received, please allow 7 - 10 business days for delivery.
•
Products may not be purchased at a local retail pharmacy or through any other
source other than the Care1st Health Plan OTC Benefit Catalog.
•
If you disenroll from Care1st Health Plan, your OTC benefit will automatically
terminate.
•
Returns are not accepted.
•
Some items listed in this catalog may also be covered under your Medicare Part B
(medical) benefit or Part D (pharmacy) benefit. These items have a *B or a *D after
their name. For example, alcohol pads are covered under Part D if they are used
for administering insulin. For all other purposes, this item is covered under your
OTC benefit.
•
Items in the 2015 OTC Benefit Catalog may change throughout the year.
A copy of this catalog is also available on the Care1st Health Plan website at
www.care1st.com/ca/medicare. For up-to-date information, please call our OTC
Advocates from Monday - Friday from 8:00am to 5:00pm PST at 1-800-355-7913
(TTY 711).